Disability and Health Data System User Feedback Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0919 can be found here:

Documents and Forms

Document Name Document Type
Disability and Health Data System User Feedback Survey Form and Instruction
DHDS User Feedback Survey Att 1a_ UserSurveyQuestions_(screenshots).docx Form and Instruction
DHDS User Feedback Survey Att 1_UserSurveyQuestions_(word).docx Form and Instruction
GenIC_DHDS Survey.docx GenIC_DHDS Survey IC Document

Information Collection (IC) Details

IC Title:	Disability and Health Data System User Feedback Survey	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	DHDS User Feedback Survey	Att 1a_ UserSurveyQuestions_(screenshots).docx		Yes	Yes	Fillable Fileable
Form and Instruction	None	DHDS User Feedback Survey	Att 1_UserSurveyQuestions_(word).docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	200	0	0	0	0	0
Annual IC Time Burden (Hours)	17	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
GenIC_DHDS Survey	GenIC_DHDS Survey.docx	05/08/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.